Many sexual health stories leave something to be desired in terms of science-based, judgment-free information. "10 Sex Things Every Woman Should Do," according to Cosmopolitan. Isn't that true for every woman? There are no exceptions!
And if you really want to make yourself feel bad, Maxim claims to know "Exactly How Much Sex You Should Have, According to Your Age." Spoiler: It's more than some of us can handle.
That is not the case in this storey. Instead, we asked UC San Francisco experts about the sexual health topics that intrigue, surprise, or are simply misunderstood by the majority of people. What we discovered isn't always sexy, at least not in a newsworthy way. However, you might learn something new. Isn't that scorching?
Adolescence: Not quite what it used to be
Until recently, standard sexual health education didn't cover much: puberty, reproduction, pregnancy prevention, and possibly some infections.
Today, sex education has grown in popularity. Many teenagers are now taught about a variety of related topics, including gender identity, sexual orientation, consent, and the fundamentals of healthy relationships. They're also having a lot less sex. In 1991, 54% of American high school students reported having intercourse; by 2019, that proportion had dropped to 38%.
Adolescents are receiving more information that will help them make decisions about their own lives and bodies. They're also more likely to use contraception when they do have sex. In 2018, the birth rate among teenagers was less than half of what it was in 2008.
According to Erica Anderson, Ph.D., a psychologist at UCSF's Child and Adolescent Gender Center, access to more data does not necessarily make sexual development easier for today's adolescents. While Anderson believes that gender identity and sexual orientation are distinct concepts, he believes that many teenagers struggle to distinguish between the two.
"There's a lot more talk among young people about exploring identities," says Anderson, who identifies as transgender. "In addition, there is a lot of confusion in individual children."
Most of her clients experiment with gender identity and sexual orientation labels long before they experiment with flirting, dating, or having sex. That's fine, says Anderson, but it also means that many young people are now exploring their sexual identities almost entirely online. She's worked with clients as young as 11 who claim to be asexual, a label she considers premature.
"It's almost as if sexuality, and even gender identity, are abstractions for this generation," Anderson observes. "Sexuality, on the other hand, is a biopsychosocial experience." You can't simply remove any physical experience.
"I'm concerned that kids are attempting to compartmentalise themselves. Many females engage in this behaviour. Before they know it, they're being watched by older men, and they're terrified. They're at a loss as to what to do with it. It's sometimes easier for them not to be sexual."
Many teenagers are also adopting gender terms that defy categorization. A few UCSF experts have noticed an increase in the number of young people who identify as gender-nonconforming, non-binary, or gender queer. According to Annesa Flentje, Ph.D., director of UCSF's Center for Sexual and Gender Minority Health, this is a positive shift.
"In the car today, my teenage son said to me, 'Did you know that all of my friends are LGBTQ?'" Flentje explains. "He says, 'Everyone is now.'" In some ways, this means that people are no longer bound by gender roles. It's taking people out of their boxes."
Anderson believes that young people frequently confuse gender identity (your internal concept of yourself as male, female, a mix, or neither) and gender expression (your external look and behaviour, which may or may not conform to traditional expectations).
"Is it possible for a female to be aggressive, a trait we often associate with males?" "Of course," Anderson responds. "The categories are more of a continuum than mutually exclusive alternatives." And it's perfectly fine to change. "Adolescents go through phases."
Nonetheless, Anderson emphasises the idiosyncratic nature of identity formation. She also works with transgender teenagers who are confident in their own identities and desires. Anderson supports medical treatment for gender dysphoria when teens are "consistent, consistent, and persistent."
Anderson says that whether her clients are discussing their gender or their sexuality, "it's generally a good idea to be accepting of a young person." I never reveal a child's identity to them. But sometimes I tell myself, 'Be kind to yourself.' You are free to change your mind. And, when in doubt, be sceptical. It's all right. 'You have time.'"
Shame: The enemy of sexual health
Shame was a recurring theme in UCSF interviews about sexual health.
Consider the topic of sexual health education. Mara Decker, Dr.PH., MHS, an assistant professor at UCSF's Institute for Health Policy Studies, believes that sex education has improved significantly in some states, including California, where she evaluates the state's programme. However, historically, sex education has often been delivered with a finger-wagging tone reminiscent of scared-straight anti-drug campaigns.
"It's no longer 'You're doomed if you do this,'" says Decker. "Ironically, by not shaming, some young people are becoming less sexually active." They believe they have a bit more control over their own decisions."
According to Decker, most public health research has found that shaming is counterproductive, whether the goal is to reduce sexually transmitted infections or drug use. This is most likely due to how awful shame can feel to those who are subjected to it. It has been linked to depression and anxiety in studies, and people who are prone to shame frequently have low self-esteem.
"Shaming dialogue completely turns people off," says Decker. "They stop paying attention. Rather than saying things like, 'Gonorrhea is horrible, and it's a sign that you're a horrible person,' which it isn't, we say, 'This is gonorrhoea.' These are the signs.'"
Many people are ashamed of wanting or having sex. But what if you don't have sex? Or do you have no interest in it? Is that a bad thing?
Tami Rowen, M.D. '09, M.S. '07, an associate professor of obstetrics, gynaecology, and reproductive sciences, brought it up before giving any advice on how to improve sexual function. Despite what other magazines may tell you, having a low sex drive isn't a problem unless it bothers you. And what if you are? That's fine, too! There is no such thing as a wrong answer.
"Sexual desire is so variable," says Rowen. "There's also this stereotype that women's sexual desire is not innate and is only responsive, which is simply not true."
Meanwhile, according to Alan Shindel, M.D., MAS, a professor of urology, men are frequently acutely ashamed of their lack of sexual desire. Their partners' expectations, whether real or imagined, can exacerbate the situation.
"There's a cultural paradigm that says men should want sex all the time," he says. "However, it's not realistic.
"It's always a bit of a dance for two people to come together and get their libidos to mesh." Communication is the secret sauce. It's amazing how often couples don't discuss sex."
Shame can also have a distinct impact on the sexual lives of LGBTQ people. Flentje's research focuses on "minority stress," which includes feelings of shame.
"People have erroneous internalised beliefs about some ostensibly heterosexual 'ideal,'" Flentje claims. "Those beliefs can obstruct not only healthy sexual functioning but also healthy psychological functioning."
Harmful beliefs manifest in a variety of ways. Some LGBTQ people suppress their sexual desires, while others use alcohol or drugs prior to sex to drown out negative thoughts. Flentje is experimenting with cognitive-behavioral therapy to see if it can reduce minority stress.
"As a 17-year-old, they may have developed an unhealthy habit of getting really intoxicated before sex," she says. "But that's just a habit." It could be that there is no longer a need for it.
"What are your thoughts on it?" Perhaps they aren't valid. We can have automatic thoughts that stem from a core belief, such as "Being queer is not okay."
These kinds of beliefs have deep roots in messages we receive as children, whether from family, peers, religion, or American culture in general. But how do you go up against a firm belief?
Flentje suggests changing your perspective. Try applying the belief to someone you care about, for example. It's not a conversation, but rather a thought experiment: how would you feel if someone spoke to you the way you speak to yourself? According to Flentje, most people are much kinder to others than they are to themselves.
Hormones can cause havoc in your relationship.
Sex hormones such as oestrogen and testosterone have a significant impact on our bodies. That influence extends to our brains and, to a lesser extent, how we think, feel, and behave. As a result, the premise of almost every romantic comedy ever made is that sometimes men and women confuse each other.
That is why UCSF's Benioff Professor of Psychiatry, Louann Brizendine, M.D., writes about the neuroscience of hormones and how they shape our romantic and sexual relationships. Brizendine's books are extremely popular despite the fact that she focuses on heteronormative partners — there aren't many studies of other identities and pairings yet.
"The Female Brain," one of Brizendine's books, became a New York Times best-seller. Whitney Cummings, a comedian, even turned it into a film.
Brizendine claims that "the male and female brains are much more alike than they are different." "However, our different hormones are programmed by nature to cause behavioural differences." This is probably not politically correct, but it is biologically correct.
"I'm making some broad generalisations here, but it's so you can step back and say, 'OK, now I understand there might be biology behind this.'" People will begin to blame themselves or others if this does not happen."
Biological differences can manifest themselves in sexual relationships in a variety of ways. For example, if popular dating shows like FBoy Island are any indication, many straight women struggle to differentiate between men who want a relationship and men who just want sex. Brizendine believes hormones are to blame for this predicament. Because of oxytocin, a feel-good bonding hormone, women may be prone to rapid attachment to an attractive partner. Intimacy, cuddling, and sex can bring it out in anyone, but the extra oestrogen and progesterone in female bodies encourage their brains to ramp up their oxytocin production, especially when they ovulate. Men may require two to three times the amount of touch as women to maintain the same level of oxytocin.
Have you ever had someone hold your hand and you instantly knew the gesture meant something special to you? You could be correct. According to Brizendine, it could also be a surge of chemicals that feels great but essentially means "your judgement is toast." It's biologically difficult for many women not to crave commitment after sex with someone they really like.
"Unless you know what biology is doing to you," Brizendine says. "We frequently have no idea who we're dating. It is critical to have quick ways to assess trustworthiness. This is a situation where you must outwit your own hormones."
Women who are committed to monogamy can accomplish this in a variety of ways, according to Brizendine. Avoid scheduling hot dates on the days closest to ovulation if you track your cycle. When you do meet, think about what you value most in a partner. For instance, does your date truly listen to you — or does he wait for his turn to speak? Delaying sex can also help keep oxytocin levels under control — and weed out dates who are only looking to hook up.
Meanwhile, Brizendine claims that testosterone causes many men to prioritise sexual conquest, particularly during adolescence. However, research suggests that social conditioning forces men to avoid and hide emotion, which may make close relationships difficult for some men to initiate or maintain.
Brizendine writes, "From childhood on, males learn that acting cool and hiding their fears are the unwritten laws of masculinity."
Brizendine, on the other hand, contends that some gender stereotypes — on average, women are more emotionally adept, men are more rational — are supported by neuroscience.
"Understanding the differences is important because it helps reset your expectations," Brizendine says. "Women may be quick to pick up on emotional nuance. What a woman might get out of one conversation, he might get out of three. Patience is required."
Brizendine also advises men to be patient with female experiences they don't understand instinctively. One common example: For many women, experiencing physical pleasure necessitates turning off the brain's fear and anxiety centres. Females' arousal and ability to orgasm can be profoundly inhibited by stress, which is why men are advised to dial up the intimacy and take it easy. Make time to converse. Let's go out to dinner. Keep those hands together! (Okay, not necessarily hands.) Any kind gesture helps to rekindle the oxytocin fire.)
"Foreplay is basically everything that happens 24 seconds before sex for a man," Brizendine says. "It's everything that happened 24 hours before for a woman."
Sexual function: Troubleshooting the genitals
While much of sexual health is psychological, the body is also very important. Let's get started with the physical stuff!
First, we'll look at female anatomy and orgasm. Scientists knew surprisingly little about the clitoris for a long time. This organ contains thousands of nerves that provide sexual pleasure to women. It has the shape of a wishbone and is larger than you might think.
Rowen explains, "We don't see the majority of the clitoral tissue." "It's deep and wraps itself around the vagina."
Is this to say that vaginal orgasms and clitoral orgasms, which were once thought to be inferior by some male physicians, are actually the same thing? Rowen claims that scientists aren't studying this thoroughly enough to know for sure. Female orgasms involving vaginal penetration, she believes, engage more muscles and thus produce different sensations, despite the fact that the nerves involved are most likely similar. What we do know is that most women require external clitoral stimulation to experience orgasm.
"People don't get it," Rowen claims. "A lot of young women come to me and say, 'I think I might have orgasmic dysfunction,' because their partners say, 'My last three partners had orgasms from intercourse.' Something is wrong with you.' No, there isn't."
Unfortunately, a variety of factors can interfere with women's enjoyment of sex. Rowen attributes this to the high dose of hormones required to stop ovulation in some women who use hormonal birth control. And, as women get older, menopause can bring on a slew of unpleasant symptoms, such as vaginal dryness and decreased libido. Fortunately, the progesterone and oestrogen used in hormone replacement therapy are far less potent than those found in the pill, so they don't dampen desire, according to Rowen.
Are you curious about how menopause affects women's lives, sexually or otherwise? "The Upgrade: How the Female Brain Gets Stronger and Better in Midlife and Beyond," Brizendine's latest book, will be released in April.
Women who want to increase their libido have some new prescription options. One example is Addyi, a drug that was initially studied as an antidepressant. (Women already taking antidepressants should be aware that many of them suppress sexual desire.) That also applies to men.) While there has been some debate about how well Addyi works, Rowen says that the majority of her patients who try the daily pill decide to continue taking it.
There's also Vyleesi, which has an indirect effect on dopamine, a neurotransmitter that fuels our desire for pleasure. It's supposed to be injected under your skin — with a needle, no less — about 45 minutes before sex. On the plus side, you can quickly see if it works, whereas Addyi can take weeks to kick in.
What about the men? There are well-established options to assist them in obtaining or maintaining an erection. You've probably heard of Viagra, one of the most commonly prescribed medications in the United States. It stimulates blood flow to the penis.
Tom Lue, M.D., Tanagho Professor of Clinical Urology at UCSF, discovered how the body traps blood in the penis during an erection and advanced our understanding of nitric oxide, which is essential to how Viagra and similar drugs work.
However, Shindel observes that the ability to obtain an erection is not always the issue. Some men simply have low libido, which may be more mental and emotional in nature than physical. Still, the problem has the potential to worsen over time.
"The analogy is, 'Who wants to play baseball if they know they're going to strike out?'" Shindel says. "They don't want to make a mistake. This creates a vicious cycle.
"However, the pills can help boost erection response in many cases, regardless of arousal or libido." Many men regain their confidence. That is psychological, but it is true."
Prostate cancer surgery or radiation can damage nerves and make erections difficult in older men. If nothing else works, surgeons such as urology professor Benjamin Breyer, M.D., MAS '11, can implant a device in the penis. When the patient desires an erection, he simply presses a small bulb in his scrotum — ta-da, science! Shock wave and stem cell therapies are two other promising (but still experimental) solutions.
"We see a lot of men in their fifties and sixties," says Breyer. "That's one of the more rewarding aspects of our work: restoring men to their pre-cancer selves." It makes a lot of people feel more normal."
Nonetheless, Breyer believes that everyone should be aware that there are far less invasive ways to improve their sexual function.
"Whatever is good for you overall is also good for sexual health," he says. "Exercise, eating well, getting enough rest, and de-stressing." "Mental health, hormonal health, vascular health... all of these intertwine and lead to sexual wellness."
